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Urological Cancers > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What are the risks of prostate cancer

A

Family history
Age
Genetics - BRCA females in the family
Ethnicity - afrocaribean and African American

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2
Q

How does Prostate Ca present

A
  1. Generally asymptomatic and picked up at screening
  2. LUTS
  3. Bone pain, loss of weight - advanced disease
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3
Q

What is the function of PSA

A

Prostate specific antigen (PSA) is a protease whose function is to break down the high molecular weight protein of the seminal contents into smaller polypeptides. This action results in the semen becoming more liquid - can be seen in regards to liquefaction time.

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4
Q

What are non cancer causes of a raised PSA

A

Urinary retention
UTI
Intrumentation eg - catheter
BPH

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5
Q

What are the benefits of prostate cancer screening

A

Screening will reduce mortality

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6
Q

What are the risks of PSA screening

A

Significant over treatment and over diagnosis as pts who are found to have cancer will die probably due to a cause other than thier prostate Ca.

Number needed to treat is very Low - 1

Gives pt anxiety, unable to be happy

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7
Q

When to do a PSA

A

If pt under 70 - explain the pros and cons and do it if pts want it

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8
Q

should you do a PSA if pt is over 70

A

No benefit on mortality therefore would over diagnose and over treat

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9
Q

What advice would pts need about PSA

A

Not a perfect test - low doesn’t exclude and high doesn’t confirm

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10
Q

What are the further investigations if PSA is raised or DRE is of malignant type

A

MRI prostate - see where the cancer is mainly located - helps to decide which of the following to do

TRUS biopsy

Transperineal/template biopsy

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11
Q

why can TRUS be dangerous and what must pts do before it

A

Pts given prophylactic abx before it to avoid risk of sepsis

This is because the biopsy is taken through the anal canal

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12
Q

why can TRUS biopsy be negative

A

Only can reach the posterior part of prostate, so if a cancer in on the anterior surface it may miss it

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13
Q

What are the benefits of template vs TRUS biopsy

A

Less risk of sepsis

More accurate

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14
Q

What is the most common type of prostate cancer

A

Adenocarcinoma

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15
Q

How is the Gleason score worked out

A

Sum of the two highest score found of the sample of 12 COREs that are taken from the biopsy

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16
Q

What is low Gleason grade

A

Gleason 3+3 = 6 ( this means that 3 was the highest scores)

17
Q

what is a intermediate Gleason score grade

A

3+4 = 7 ( both 3 and 4 found but more 3 than 4s )

18
Q

What is high Gleason score

A

4+3 =7 ( this means that both 4 and 3 grade were found but more 4 compared to 3)

19
Q

How many grades are there for Gleason score

A

3,4,5

1 and 2 not used any more

20
Q

Explain watchful waiting vs active surveillance

A 
Active surveillance ( monitor with a intention to treat further down the line ) - used for low Gleason scores 3+3 
Monitor DRE/PSA every 6 monthly. If increases then treat radically 
If doesnt increase then avoids unnecessary treatment

Watchful waiting - monitor with a intention to provide symptomatic relief in the future, pts are generally too unwell to have surgery. Therefore treat with hormones

21
Q

What is a radical prostatectomy

A

Removal of prostate and seminal vesicles - done robotic mainly

22
Q

What are the risks of radical prostatectomy

A

Incontinence

Impotence - ED

23
Q

What are the radical treatments for prostate cancer

A
  • Prostatectomy
  • external beam radiotherapy + hormones
  • brachytherapy
  • HIFU and cryotherapy
24
Q

What is external beam radiotherapy + hormones

A

6 months radiotherapy

3 years of hormones are

Less risk of incontinence but more bowel SE

25
Q

what is brachytherapy

A

Implantation of radioactive seeds/wires

26
Q

what is the treatment for metastatic disease

A

Bicalutamide - 28 days ( testosterone receptor antagonists)

then LHRH analogue injection 14 days after. given monthly then 3/6 monthly when stable

Bicalutamide will act as testosterone cover as with LHRH analogue testosterone will increase initially

27
Q

What is the treatment for castrate resistant prostate cancer

A

Castrate resistant means - rising PSA despite hormone therapy

Add bicalutamide back in
Dexamethasone

Urological Cancers (7 decks)

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